Provider Demographics
NPI:1326028325
Name:SQUERI, CHRISTINE D (OD)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:D
Last Name:SQUERI
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1080 5TH AVE # 1C
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-0102
Mailing Address - Country:US
Mailing Address - Phone:609-577-8542
Mailing Address - Fax:
Practice Address - Street 1:1080 5TH AVE # 1C
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10128
Practice Address - Country:US
Practice Address - Phone:609-577-8542
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-18
Last Update Date:2018-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV008553-1152WP0200X
NJ27OA00568200152WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WP0200XEye and Vision Services ProvidersOptometristPediatrics